腹部闭合性损伤 PPT课件.pptx

腹部闭合性损伤腹部闭合性损伤BLUNT ABDOMINAL TRAUMA概述病因及分类临床表现诊断处理病因及分类腹部损伤常见于交通事故，故意伤害和工业事故。70-80%需要手术治疗。一般分为开放性和闭合性。医源性损伤更应重视！临床表现表现差异大内脏损伤主要表现为腹腔出血和腹膜炎。实质脏器，空腔脏器。因时间，损伤强度而表现不同。综合动态分析很重要。诊断主要依据：病史，体格检查，相关辅助检查。有无损伤，实质还是空腔脏器，可能的器官，损伤程度等。诊断性腹腔穿刺及腹腔灌洗。X线B超CT诊断性腹腔镜剖腹探查术ALGORITHM FOR THE EVALUATION AND MANAGEMENT OF BLUNT ABDOMINAL TRAUMA处理注意多发伤静脉通路的建立急救流程的执行非手术治疗及观察手术治疗损伤控制性手术DCS（damage control surgery）MDT及ICU的价值实质性脏器损伤特征及处理肝脏损伤脾脏损伤胰腺损伤十二指肠损伤*肝脏损伤分类：包膜下血肿，真性破裂，中央破裂。分级：损伤范围，深度，是否伴有重要血管损伤。非手术治疗手术治疗修补术，肝部分切除术，纱布填塞法，损伤控制手术，介入治疗。GRADE 4 LIVER LACERATION INVOLVING THE RIGHT HEPATIC LOBE ON ABDOMINAL CT SCAN.NOTE THE FOCUS OF ACTIVE CONTRAST EXTRAVASATION WITHIN THE INJURED LIVER PARENCHYMA AT THE PERIPHERY OF THE INJURY(ARROW)脾脏损伤分类：中央型破裂，被膜下破裂，真性破裂。注意延迟性脾破裂。分级非手术治疗手术治疗保脾手术，脾切除，自体性脾移植术。SPLENIC INJURY WITH SUBCAPSULAR HEMATOMA.DESPITE ONLY A 1-CM CAPSULAR TEAR,THIS INJURY DEMONSTRATED ONGOING HEMORRHAGEGRADE 3 SPLENIC LACERATION ON ABDOMINAL CT SCAN.NOTE THE FOCUS OF ACTIVE CONTRAST EXTRAVASATION WITHIN THE INJURED SPLENIC PARENCHYMA(ARROW)胰腺损伤分类：单纯挫伤，深部撕裂伤，胰腺断裂，胰头挫裂伤，合并十二指肠损伤等。术前CT检查关键损伤分级：轻度，重度，胰管损伤及断裂。术前评估手术原则：彻底清创，确切止血，控制胰腺外漏，处理合并伤及通畅引流。PANCREATIC INJURY ON ABDOMINAL CT SCAN.THE INJURY INVOLVES THE PANCREATIC NECK AND APPEARS AS A 2-CM SEGMENT OF NONPERFUSED PANCREAS TISSUE,WITH SURROUNDING EDEMA(ARROW)ALGORITHM FOR THE OPERATIVE MANAGEMENT OF PANCREATIC INJURY十二指肠损伤*损伤分级挫伤，撕裂伤，血肿，穿孔，破裂，断裂，肠管组织缺失。术前评估发现时间长短，组织水肿情况，肠管缺失程度，合并伤，出血等手术治疗单纯修补，带蒂肠片修补，肠肠吻合术，憩室化手术，胰十二指肠切除术等。